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Renal
Chapter 28 Kidney Disorders
| Question | Answer |
|---|---|
| Age-related changes in kidney function | Increased resistance to ADH Kidneys less able to concentrate urine Potassium excretion decreased |
| Symptoms of pt with renal tumor | - Often asymptomatic - Gross hematuria - Flank pain - Palpable abdominal mass |
| Systemic manifestation of renal tumor | - Fever without infection - Fatigue - Weight loss |
| Kidney Cancer (Renal Cell Carcinoma) | - Most common type of kidney cancer |
| Systemic effects of Renal Cell Carcinoma | - Anemia - Erythrocytosis - Hypercalcemia - Liver dysfunction w/elevated liver enzymes |
| Kidney cancer often occurs in which age of patients? | 55-60 years of age |
| Major concern for surgical treatment of kidney cancer | Blood loss during and after surgery |
| Monitor post surgical kidney cancer patients for | Hemorrhage and adrenal insufficiency |
| What is used for targeted therapy in renal cell carcinoma? | Nexavar and Torisel |
| Kidney Failure | Kidneys unable to effectively remove accumulated metabolites from the blood |
| Kidney Failure | Leads to altered fluid, electrolyte and acid-base balance |
| Renal replacement therapy | Hemodialysis Peritoneal dialysis |
| Intermittent hemodialysis | Blood taken from patient and pumped to dialyzer (ultrafiltration) |
| Complications of intermittent hemodialysis | Hypotension, bleeding and infection |
| Nonsurgical management of kidney cancer | Radiofrequency ablation can slot tumor growth |
| Kidney cancer | Chemo has limited effectiveness against this cancer type |
| Nonsurgical management of kidney cancer | Interleukin-2 and tumor necrosis factor (TNF) lengthens survival times |
| Interleukin-2 | Protein that regulates the activities of white blood cells that are responsible for immunity |
| Tumor necrosis factor (TNF) | Superfamily of cytokines that can cause cell death |
| Cytokines | Any of a number of substances, such as interferon, interleukin, and growth factors, that are secreted by certain cells of the immune system and have an effect on other cells |
| Nexavar (Sorafenib) | Used to treat kidney, liver, and thyroid cancer. (Chemotherapy medication) |
| Torisel (Temsirolimus) | Used to treat advanced kidney cancer. (Chemotherapy medication) |
| Complications of surgical procedure for kidney cancer | Decreased blood pressure |
| Diagnostic tests for kidney cancer | - Renal ultrasonography - CT scan - Chest x-ray, bone scan, MRI, liver function studies |
| Continuous renal replacement therapy (hemodialysis) | - Porous hemofilter for 8-12 hrs - CVVH - Continuous venovenous hemofiltration - CVVHD - Continuous venovenous hemodialysis - CVVHDF - Continuous venovenous hemodiafiltration |
| Long-term vascular access devices for hemodialysis | - Ateriovenous fistula (AVF) - Ateriovenous graft |
| Temporary vascular access devices for hemodialysis | - Hemodialysis catheter (dual/triple lumen) - Ateriovenous shunt |
| Complications of access devices | - Thromboses - Clotting of AV access - Graft fail |
| Most common type of peritoneal dialysis | - CAPD (Continuous ambulatory peritoneal dialysis) - CCPD (Continuous cycling peritoneal dialysis) |
| CAPD | Not attached to pt. Pt able to ambulate. |
| CCPD | Pt attached to cycler at night while sleeping. Exchange takes 8-10 hours. |
| CAPD or CCPD | Less effective but more continuous metabolic clearance (avoids fluctuations) |
| Complications of peritoneal dialysis | - Peritonitis - Body image disturbance |
| Chronic Kidney Disease | Prevalent among people 65 and older |
| Pathophysiology of Chronic Kidney Disease | - Glomerulosclerosis; hardening of the glomerulus in the kidney - Interstitial inflammation: swelling between the kidney tubules - Fibrosis: thickening and scarring of connective tissue |
| Chronic Renal/Kidney Disease | - Gradual irreversible kidney damage and loss of function - Eventually unable to function adequately, leading to ESRD |
| Leading cause of End-Stage Renal Disease (ESRD) | Diabetes |
| Stages of Chronic Kidney Disease (CKD) | - Decreased renal reserve - Renal insufficiency - Renal failure - ESRD |
| Early-stage CKD manifestations | - Proteinuria, hematuria, polyuria, nocturia - Dehydration - Fixed specific gravity: SG of 1.010 regardless of fluid intake |
| Manifestations of CKD | - Uremia, nausea, apathy, weakness, fatigue |
| Fluid and electrolyte effects of CKD | - Proteinuria, hematuria, hyperkalemia - Metabolic acidosis |
| Cardiovascular effects of CKD | - CVD leading cause of death - Accelerated atherosclerosis - Systemic hypertension - Pericarditis |
| Hematologic effects of CKD | - Anemia - Epistaxis: nose bleeds - GI bleeding |
| Immune system effects of CKD | - Increased risk of infection - Fever suppressed |
| GI effects of CKD | - Anorexia, nausea, and vomiting - Hiccups, gastroenteritis frequent - Uremic fetor |
| Neuro effects of CKD | - CNS changes - Peripheral neuropathy - Restless leg syndrome |
| Musculoskeletal effects of CKD | - Renal osteodystrophy (rickets) - Bone tenderness, pain, fractures |
| Endocrine and metabolic effects of CKD | - Reproductive function impaired |
| Derm effects of CKD | - Pallor, yellowish hue to skin - Uremic frost: crystallized urea deposits on skin of pt w/CKD |
| Diagnostic tests for CKD | – Urinalysis, urine culture – BUN, serum creatinine – eGFR – Serum electrolytes – CBC – Renal ultrasonography – Kidney biopsy |
| Treatment Medications for CKD | – CKD affects the pharmacokinetic/pharmacodynamic effects of drug therapy. – ACE inhibitors and ARBs (angiotensin II receptor blockers) – Diuretics or other loop diuretics |
| Treatment Medications for CKD | – Drugs to manage CV disease, electrolyte imbalances/acidosis – Folic acid and iron supplements |
| Nutrition and fluid management for CKD | – Prevent protein-calorie malnutrition – Regulate, restrict sodium intake |
| Hemodialysis | - Occurs in dialysis center - Usually 3 times/wk (9-12 hrs/week) |
| Hemodialysis | - Most common therapy for ESKD. - Removes excess fluids and waste and restores chemical and electrolyte balance by passing patient’s blood through an artificial semipermeable membrane. |
| Post-dialysis care | – Monitor vital signs and weight for pre-procedure comparison. – Avoid invasive procedures 4 to 6 hours after dialysis. – Continually monitor for hemorrhage |
| Post-dialysis complications | – Dialysis disequilibrium syndrome – May develop after initial, rapid HD has been completed |
| S&S of Dialysis disequilibrium syndrome | - HA, N&V, restlessness, Dec LOC, inc intracranial pressure, seizures |
| Post-dialysis complications | - Infectious diseases – most serious: - Hepatitis B and C infections - HIV exposure—poses some risk for clients undergoing dialysis |
| Peritoneal Dialysis (PD) | - Uses body’s own peritoneal membrane which lines the abdominal cavity as the semi-permeable membrane to filter out excess fluids and electrolytes and end-products of metabolism |
| Complications of PD | - Peritonitis – major complication - Pain - Exit site and tunnel infections - Poor dialysate flow – re constipation - Dialysate leakage |
| Nursing Care During PD | - Before treating, evaluate baseline VS, wt, and lab tests. - Continually monitor for respiratory distress, pain/discomfort. - Monitor prescribed dwell time and initiate outflow. - Observe the outflow amount and pattern of fluid. |
| Kidney transplant | - Treatment of choice for patients with ESRD - Improves quality of life - Most obtained from deceased donors - Meet criteria for brain death - Less than 60 years old - Free from disease, malignancy, infection |
| Kidney transplant | - Renal artery, vein, ureter anastomosed - Immunosuppressive drugs minimize response to reject organ. - Hypertension possible complication - Infection is a continuing threat |
| Health promotion for kidney transplant | - Kidney disease prevention - Diabetes and hypertension management - Treatment of infections - UTI prevention - Maintenance of proper blood pressure and blood glucose levels - Hydration of patients with compromised renal function |
Created by:
pdimple
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